CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Carilion Franklin Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $2,298
Cash Discount Price: $1,463
vs. Medicare Baseline: 1.88x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Carilion Franklin Memorial Hospital is $2,298. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,463. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.88x the Medicare baseline. Located in 180 Floyd Avenue, Rocky Mount, VA.

Cash / Self-Pay

$1,463

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,298

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,222.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,222.56 (100%)

Cash / Self-Pay: $1,463 (120%)

Insurance Median: $2,298 (188%)

Cash: $1,463 (120% of Medicare)

Ins. Median: $2,298 (188% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,222.56 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$388 - $5,864	32%
Sentara Health Plan	$395 - $2,591	32%
Abh Of Va (Formerly Coventry)	$406	33%
Abh Of Wva (Formerly Coventry)	$406	33%
Humana	$406 - $1,140	33%
UnitedHealthcare	$406 - $3,416	33%
Aetna	$1,051 - $2,775	86%
Gateway - Tier 3	$2,298	188%
Vhn - Ultra	$2,591	212%
Cigna	$2,817 - $3,009	230%
Connecticare	$2,925	239%
Vhn - Plus	$3,218	263%
Gateway - Tier 2	$3,343	273%
Vhn	$3,343	273%
Vhn - Link	$3,761	308%
Gateway - Tier 1	$3,970	325%
Vhn - Secondary Payors	$3,970	325%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,463.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45380.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Carilion Franklin Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45380.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.